Intramyocardial dissecting hematoma: a case report
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The present case has been reported in the journal IHJ Cardiovascular Case Reports.

A 50-year-old male presented on the 2nd day of acute ST-segment elevated anterior wall myocardial infarction (AWMI). Except for the smoking, he had no other risk factors for coronary artery disease (CAD). His troponin levels are 10 ng/ml and electrocardiogram showed ST elevation in lead 1, lead avl and lead V1V4 and Q waves in lead V1V4. He was hemodynamically stable and managed medically with dual antiplatelets, high-intensity statins, anticoagulation, beta blockers, and angiotensin converting enzyme inhibitors (ACEi).

On 3rd day he underwent echocardiography, there was hypokinesia of the apical septum, apico anterior segment, mid anterior segment and apex with the ejection fraction of 44%. There was evidence of crescentic shaped, serpiginous and echo-lucent area within the left ventricular myocardium.

This was lined by endomyocardium from the inner side and also having a myocardial layer on the outer side. There was also evidence of “the rent” on the inner endomyocardial border of this defect and color flow was demonstrated inside this cavitary defect. So on basis of these findings, a final diagnosis of IMDH was made which was further confirmed by cardiac MRI.

It was concluded that delayed presentation was a major contributor to the occurrence of the IMDH in this case. The patient was managed conservatively and discharged after six days of the uneventful hospital stay.

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